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- Page navigation anchor for RE: The status quo is not an evidence based optionRE: The status quo is not an evidence based optionThe NHS Health Check is a strategic response to the growing burden of non-communicable disease, and with optimal delivery is predicted to prevent substantial numbers of premature deaths, cardiovascular (CVD) events and cases of diabetes.1 To achieve this, the programme has three components: risk awareness, risk assessment and risk management.Mant2acknowledges the pressing need for earlier identification of CVD risk, hypertension, diabetes and kidney disease (CKD). He identifies some questions raised by recent research but underlines that evidence is inconsistent. He suggests that the NHS Health Check should be abandoned, but offers little alternative beyond usual primary care. We would challenge that an approach dependent on the status quo can be justified when, despite almost universal registration with a GP, around 5 million people in England have undiagnosed hypertension, 1.6 million undiagnosed CKD and 700,000 undiagnosed diabetes.The editorial suggests that the NHS Health Check should be abandoned partly because it is inefficient at case-finding. The evidence for this derives from a single study3 whose authors reported that the NHS Health Check was no better than usual care at case-finding. This study had significant limitations (not randomised, underpowered and low health check uptake) and the findings do not justify abandonment of the NHS Health Check. Rather, wh...Show MoreCompeting Interests: All of us are employed by PHE.
- Page navigation anchor for RE: Health checks and screening : what works in general practice?RE: Health checks and screening : what works in general practice?
Professor Mant has analysed the weaknesses in the NHS Health Checks programme but there is a simple way to make it more effective.1
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The GP model is to treat patients who present with symptoms and to encourage them to return for appropriate check ups. Diagnosing hypertension and diabetes may require further appointments but GPs and patients are not always successful in making the follow up consultations happen. At every practice there will be patient records with raised blood pressure, blood glucose and cholesterol which have not been monitored to a conclusion.
The NHS Health Check is effectively a mass screening programme of non morbid people aged 40-74. More people are being found with raised risk factors and many of them are not being followed up. Health Checks can be carried out by health care assistants and it may be that a nurse or GP never gets to see the person with raised blood pressure. NHS Health Checks may not be delivering as many extra diagnoses as might be expected but the raised risk factors are usually recorded on the patient record.
It is assumed that GP practices already provide follow up monitoring but in reality this varies considerably from practice to practice. A study has shown that the proportion of un-monitored, at risk patients can vary between neighbouring practices by a factor of ten (see appendix).
If we are serious about earl...Competing Interests: None declared.